A Sketch (Analytical) of the History and Cure of Contagious Fever

Although our Readers, as well as ourselves, have just cause to be tired of the subject of this volume; yet while fever continues to ravage on the vitals of the community, arid men of experience to lay before their brethren the results of their observations, it is the duty of the Journalist to pourtray, and of the Reader to patiently audit, these records of passing events, in which all are more or less concerned.

nity, arid men of experience to lay before their brethren the results of their observations, it is the duty of the Journalist to pourtray, and of the Reader to patiently audit, these records of passing events, in which all are more or less concerned.
Few Authors are more entitled to profound and respectful attention than the venerable Dr Jackson. The materials of his observations have been drawn from a boundless and fertile field of personal experience, during a period of little less than half a century ; and that too with an active mind particularly directed to the investigation of febrile diseases. The sentiments of such a man carry with them a.more than common degree of influence, since it is evident that they are not the results of first, and too often false impressions, but portraits corrected by time, reflection, and ample observation.
It is well known to our Readers, that Dr. Jackson's system of practice in the endemic fevers of unhealthy climes, was often stigmatized by our brethren at home as rash, or at least as ultra-depletory. However that may be, the volume now under review evinces no indications of rashness, hut, on the contrary, forms a useful monitor to the ultraphlebotomists of the present dny In upholding the propriety of venesection in most of the complicated or ag- [Aprij gravated forms of contagious fever, our Author wisely admits that blood-letting is by no means indispensably necessary in the simpler forms of this disease. He justly observes also, that " the power of the remedy is augmented by management;" since the abstraction of blood, merely as such, may be dangerous, unless executed with other accompaniments, as the warm bath, frictions, &c.
Dr. J. in his preface, throws out an opinion, which appears in unison with some continental theories, namely, that " the action of a febrile disease is principally manifested upon one system or series of parts ; in the cutaneous expansions, internal or external." From this view, he presumes that fever is most speedily cured by those remedies which act directly and immediately upon the series of parts effected?" that is, the exhalents of the skin." The greater part of the volume before us is occupied with a most interesting and instructive medical history of contagious fever, as it appeared on the Continent, in the British Isles, and in British Colonies, since the revolutionary war, among the armies, corps, or regiments, with which our author served. These histories are totally incapable of analysis, and must be attentively perused in the original by those who wish to see the facts and material? from which Dr. Jackson drew his doctrines and conclusions. We shall therefore pass at once to his " remarks on the prevailing epidemic." " Contagious fever, as it appears in fleets and armies, is almost always, if not always, an artificial disease, viz. the product of the accumulation of many persons under canvas in the field; in the narrow between decks of transport ships, or in damp and ill ventilated barracks. It has often a similar origin among masses of manufacturers, shut up in ill ventilated work-houses, or lodged in damp end ill ventilated cellars as places of dwelling. The disease, as originating froni a common cause, is analogous in general form; it is modified more or less in appearance by circumstances of place or subject. A condition of atmosphere, artificially produced by aggregation and want of due ventilation, acts adversely on human health. It occasions a disease which, in the course of its proceeding, generates a material which is communicable to others, and which, thus communicated, propagates its kind through a series; in other words, becomes contagious." P. 147.
We need not observe that these are, and have long been, our own sentiments precisely. The testimony of a Jackson, on a matter of fact and observation like this, is, in itself, a host, and absolutely paramount. What may be the exact nature of the adventitious or febrific substances 1820.3 Di"' Jackson on Contagious Fever. 531 dispersed through the atmosphere, during epidemic constitutions, our Author does not pretend to explain. But it is evident that they are more concentrated at some points of the earth's surface than at others, and that they are modified by the revolutions of the seasons. The fever, which has been epidemic for a few years past in Great Britain and Ireland, Dr. Jackson pronounces to be " decidedly contagious;" though, in numerous instances, it arises from " a secret quality in the constitution of the atmosphere," at present unknown. He thinks the gastric form of fever, which is that most prevalent in Great Britain of late, is also that form which is most " readily convertible to contagious action." " The febrile act was principally manifested on serous secretions, or exhaling surfaces within the abdominal cavity; on the peritoneal surfaces, the interior of the alimentary canal, and, by continuity, on the exhaling surface of the skin." Analytical Reviews.
[April when in excess, instead of proceeding on any one routine principle of practice. Pathology. As the contagious miasma which excites fe ver is invisible, so, in general, " the effect which the febrile act produces, is, in like manner, invisible." '''If this be so, and it is reasonable and almost demonstrative that it is so, we are warranted to conclude that the changes which appear in organic structure after death, are changes contingent to the action of common disease, not the direct product of the action of the contagious process The action of the contagious cause, which appears to be directed to surfaces of serous, invisible secretion, cutaneous or other, is in some manner constrictive. It operates a change in the qualities of the secretion ; but it operates with so little violence, that no perceptible trace is left behind as a mark of the operation. Adhesion, purulent suppuration, congestion, &c. are foreign to its nature. But, though a visible change of structure does not belong to the operation of the cause of this form of disease, visible, and even considerable changes aie observed not (infrequently in the bodies of those who die within the limit of the disease's action. They may, in so far as I have observed, be comprehended under the following heads. Where convulsion or other violence was the forerunner of actual death, the sinous veins withm the head were generally turgid, literally engorged with black bl<*)d, more especially in relapse. Where the violence of the disease ceased suddenly, by what seemed to be an explosion of gangrene on an internal part, the peritoneal coat of the intestines was often in a state of black gangrene, without maiks of local inflammation having preceded ; the liver, spleen, and sometimes the lungs, were filled with grumous blood. These appearances occurred frequently, as the first act of the disease in its relapsed form, in highly infected and ill ventilated hospitals, in cold, damp, and foggy weather; they were rare in the opposite circumstances. The contagious fever, when of a protracted course, often assumed the dysenteric form ; and in such form often terminated fatally. W here the termination was fatal, the inner coats of the alimentary canal were often loose and dissolved into bloody mucous, sometimes ulcerated and deeply corroded, oftener separated generally, almost through the whole extent; the exterior coat, black as if gangrened. Serous effusions into the ventricles in the brain, into the thorax and other cavities were observed occasionally.
The substance of the brain was sometimes firm and full; sometimes flaccid and liquescent Suppuration in some cases, adhesions in otheis, were observed, in different places ; but these, and most others were contingent to the disease, not the effect of the action of the disease itself. The stomach and intestinal canal were sometimes pale, colourless, and inflated ; sometimes flaccid, withered, dry, without moisture or unctuosity. This condition, which was not an unfrequent one, may be thought to be more nearly connected with the radical character of the disease than any of the others." P. 198.

1820.]
Dr. Jackson on Contagious Fever. 533 Ireatment. Our author observes, that the doctrines of debility and stimulation, which were almost universal in Great Britain, prior to the close of the last century, could not be said to lead to inert practice. The latter " produced changes, which, on some occasions, subverted the diseased course; it produced effects on others which accelerated or precipitated death." Without any fixed principle to guide them, some practitioners, assuming the existence of imflammation, congestion, or other derangement in the hepatic system, prescribed mercury in fever, and " the effect on the general issue of the disease was not unfrequently favourable." In other cases, the supposition of intestitinal torpor suggested the idea of purgation, which was carried to a great extent by many, and, " in numerous instances, with benefit." " From the decided benefit which followed the application of it in many cases, cold affusion was regarded, atone time, as a remedy of great promise: ? it is useful; it is, however, like the two preceding, a remedy of circumstance only." P. 224. Before our author enters on blood-letting, as a remedy in this disease, he [naturally adverts to its pathology. Far from believing that fever has always a certain local habitation in the brain, he is not even satisfied that the " febrile act" is, in reality, a mode of inflammation. tioners at the early stages of contagious fever. They are of great value ; judiciously managed, they often cut off the disease in its beginnings. I prefer emetics of severe operation, such as occasion sickness of long continuance. Purgatives of brisk operation, viz. jalap with calomel, emetic tartar or James's powder, and a small quantity of opium, had singular, good effects in diminishing violence and danger, where the symptoms indicate mesenteric congestions, or where the disease is accompanied with intestinal torpor or irregular action in the bowels. Blisters applied to the temples, nape of the neck, and extended down the spine to the interval between th?
shoulders, are frequently employed at the earlier stages of this dis-?ase; they are employed with a marked good effect. Warm fomentations to the feet and legs, scrubbing of the skin with soap and brushes, warm bathing, followed by cold affusions, &c. often arrest the disease. Gestation in the open air, continued for a length of time, was a prescription of necessity, oftener than design; but it was mainly conducive, where employed, in confirming the health that was restored by the judicious and prompt application of |th? means now mentioned. The contagious action of the disease, I have reason to think, may be extinguished by the prompt and effectual application of the means stated; but, as complications aris? not unfrequently during the course, especially at late periods, considerable modification is required to meet the circumstances of the ease.

P. 232.
We cannot enter on the didactic sections which makeup the remainder of this valuable work, but must recommend them to the careful study of our brethren. Neither need we say any thing of the general merits of the publication.
Dr. Jackson's name has, for many years, been a passport to professional respect and favour ; and the work under review affords a convincing proof that hoary time has chilled nothing of that Zealand vigour of intellect so long and so successfully directed towards the advancement of medical science, and the mitigation of hnman afflictions J Stat sua cuique dies; breve et irreparabile tempus Omnibus est vitse: sed famam extendere factis, Hoc virtutis opus.